Facelift

A facelift is a cosmetic procedure designed to transfer the skin and deeper soft tissues of the face and neck into a more elevated, youthful position. This goal is accomplished by gaining broad access to the undersurface of the skin of the face and neck from incisions that are strategically placed to remove the excess skin and hide the scars in locations that are generally well concealed. The skin is freed from underlying attachments in the cheek area, the jaw-line and the neck so that it can be lifted and repositioned in a manner that restores a firm, more youthful, refreshed look.

Best Candidates

A good candidate for a facelift will have the following circumstances:

Good physical and psychological health

Excess skin of the face and/or neck due to heredity, aging, or loss of elasticity

A desire to rejuvenate the aged appearance of the face and neck

Realistic expectations

Non-smoker

If these circumstances apply to you, it is likely that you are a good candidate for a facelift. We hope you will contact us at Bowers Plastic Surgery by calling 336-907-7980 or Contact Us to arrange a consultation with Dr. David Bowers.

Techniques

Techniques for facelift vary depending upon the surgeon’s preference. Some surgeons make the upper incision within the hair of the temple area. Others begin under the side burn. Almost all techniques utilize an incision that continues just in front of the ear, behind the ear, over to the hairline in back of the ear, and finally down the hairline behind the ear. All of these sites are fairly well camouflaged either by hair or well-established creases. An additional small incision is often made in the crease under the chin to permit suture tightening of the superficial neck muscle (platysma).

The depth at which the tissues are freed and lifted also varies depending upon surgeon preference. It might be done just beneath the skin, underneath the dense lining overlying the facial muscles (the SMAS), or very deep underneath the facial muscles (subperiosteal).

The Surgery

The surgery is performed in an outpatient setting under either sedation (“twilight” anesthesia) or general anesthesia. This is a joint decision by the surgeon and his patient. A facility that has a board certified anesthesiologist provides an additional measure of anesthesia expertise. . A standard facelift usually requires 3 to 4 hours.

Dr. Bowers will formulate an operative plan that is tailored to your particular needs. He prefers to place the incisions so that there is minimal damage to hair and no removal of hair-bearing skin as excess skin is trimmed. The incision begin just under the side-burn, continues in a crease in front of the ear, under the earlobe, in the deep fold behind the ear, and down the hairline behind the ear. An additional small incision is often made in the crease under the chin as well. This approach permits broad access underneath the skin of the cheek, jaw-line, and the neck from one side to the other. An additional small incision is often made under the chin where it is usually inconspicuous. This incision allows the surgeon to suture together the sagging edges of the neck muscle (platysma muscle) if need be. Suturing the edges of this muscle can give the neck a smoother, more youthful appearance.

Many surgeons also make an incision in the dense lining (the SMAS) that covers the facial muscles. This deeper layer can be lifted upward and backward with sutures and provide added support for the lifted skin.

Finally, the skin that has been lifted off of the underlying tissues in the cheek, jaw-line and neck can be lifted upward and somewhat backward into a more youthful position. The excess skin is removed with care. Precautions are taken to avoid the removal of too much skin that can cause a very tight, unnatural, “operated” look. The incisions are closed in multiple layers in an effort to achieve the thinnest scar possible. The application of dressings and a supportive bandage completes the operation.

Recovery

Most patients describe a burning discomfort in the incisions around the ears and some soreness in the cheeks where the layer overlying the muscles has been tightened. This discomfort usually subsides within a few days. It is normal to experience a fair amount of swelling and bruising after a facelift, which generally begins to improve after 48 hours. The skin of the face and neck that has been lifted will be numb immediately following surgery. This numbness is usually temporary with gradual improvement over a period of weeks. Itching commonly accompanies this process of sensory recovery.

The incisions will have some drainage and some redness initially. The drainage will stop in a few days, but it is normal for scars to retain some redness for weeks after any surgery. This redness may be covered with make-up once the sutures in front of the ear are removed the following week. A few sutures are often left in place behind the ear until the second week.

Dr. Bowers recommends a soft diet during the first week to avoid excessive chewing. You should be able to shower and wash your hair within 24 to 48 hours. It is important to limit your activities such as exercising and strenuous housework four about four weeks in order to prevent aggravation of the surgical swelling. A gradual return to activities is permitted at that point.

Most patients take one to two weeks off from work depending upon how self-conscious they are about bruising and swelling. The vast majority of patients feel comfortable in public within two weeks.

Risks

All surgeries have risks including bleeding, infection, healing problems, unsightly scarring, permanent loss of sensation, and anesthesia-related complications. Other potential risks related more specifically to facelift include damage to a nerve that animates a muscle of facial expression and loss of some of the skin used to close the incisions. Although significant complications are rare, Dr. Bowers will be sure to discuss them carefully and answer any questions you may have. With regard to any surgery under consideration, it is important to be fully informed about it. You may be assured that Dr. Bowers will take great precaution to perform your surgery safely.

Costs

Although the cost of the surgery itself varies little, there is variation in anesthesia and outpatient surgical facility fees depending the time needed in any given case. Our office manager will discuss costs with you and provide you with a written quote.

Commonly Combined Procedures

A facelift can be safely combined with body contouring procedures, but it is most frequently performed in conjunction with other facial rejuvenating surgeries such as blepharoplasty (eyelid surgery) and brow lift. Sagging skin of eyelids and eyebrows is not addressed by facelift surgery. These areas can be improved by separate procedures performed at the same time as the facelift.

If you are interested in facelift surgery or a procedure to restore a more youthful look for the eyelids or eyebrows, please call us at 336-907-7980 or Contact Us. We look forward to arranging your visit with Dr. Bowers.